Foreword
When we consider Kupona Foundation, CCBRT and the future of our partnership we always come back to one thing: opportunity.
Our programs are unlocking opportunities for people in Tanzania that had been stolen from them by a lack of access to quality
healthcare. Receiving an education and securing meaningful employment is more likely when a person is healthy. This is
transformative – not just for the individuals in question, but for their families and communities too.
We also see huge opportunity for individuals and institutions in the United States. We enable our supporters to feel connected to
tangible impact and to play a direct role as part of a community that is changing lives. We empower our supporters to invest in
programs with the confidence that they combine transparency, sustainability and creativity, driven by a deep rooted understanding
of the local context.
2015 was Kupona’s most successful year yet, mobilizing over $1 million in financial and in kind support for a range of programs,
all designed to provide high quality services not only for the people in need of care today, but for future generations. This is more
than double our programmatic spending in 2014. We’d like to take this opportunity to thank all of our supporters for the role you
have played in Kupona’s growth in 2015, and for your contributions to unlock the potential of people and communities living in
poverty in Tanzania.
Following four years of committed leadership, Yoni will step down as Chair of the Board of Directors in 2016. Yoni will continue to
serve as a member of Kupona’s Board, and is looking forward to supporting the incoming Chair and their vision for the future of
our organization.
We hope that this Annual Report will provide an encouraging update to our current donors and partners, and entice new supporters
to join us. Stories of individual lives changed, figures that depict the scale of our collective impact, and testimonies from fellow
members of our community all come together to encapsulate a year where we embraced opportunities to unlock potential like
never before.
We’re excited to see what 2016 will bring.

4

Abbey Kocan

Dr. Yoni Barnhard

Executive Director

President, Board of Directors

5

6

A Word From Our Sister Organization
2015 was a key milestone in CCBRTâ&#x20AC;&#x2122;s organizational development. We implemented several initiatives to increase efficiency
and improve quality, and broke ground on our new private clinic to scale our social enterprise model in order to become
more financially independent.
Knowing that we have the dedicated support of Kupona, our little sister, is so encouraging to the team here in Tanzania.
With Kupona tapping resources we would otherwise struggle to access, we at CCBRT are able to focus on our two biggest
priorities: our patients and our people.
The financial support for service delivery and training, the advice from technical experts, and the supplies donated in kind
provide comprehensive support for our full range of programs, helping us to manage significant growth without compromising
quality.
Kuponaâ&#x20AC;&#x2122;s unrelenting focus on finding the best solutions for the local context, and their commitment to uncovering creative
ways to help us realize our ambitious goals, means that we never feel alone. They adopt our vision as their vision, our
challenges as their challenges. They are an invaluable part of our team.
Thank you to the entire Kupona community for your contributions to our success in 2015, and congratulations on achieving
the biggest year in Kuponaâ&#x20AC;&#x2122;s history. Lives and communities have been changed by your support.

Erwin Telemans
CEO, CCBRT

7

Background
Kupona Foundation (Kupona) is a nonprofit committed to unlocking
the potential of people and communities living in poverty in Tanzania.
It starts by improving their access to quality, comprehensive healthcare.
Kuponaâ&#x20AC;&#x2122;s vision and mission are directly aligned with our sister
organization, CCBRT (Comprehensive Community Based Rehabilitation
in Tanzania). CCBRT is a leading provider of affordable, high quality
healthcare in Tanzania. Together, we fuse sustainable strategies and
transparent practices with deep rooted local expertise to direct resources
to programs with the greatest potential for long term change.
Our collaborative partnership with CCBRT gives individuals and
institutions in the United States the opportunity to foster direct, local
impact, empowering people and communities to realize their full
potential. Kupona convenes a community of donors, technical experts,
advocates and volunteers to find and support creative ways to mobilize
resources and activate awareness, with a view to enabling CCBRTâ&#x20AC;&#x2122;s lifechanging programs and sustainable growth.
Together, we can change the face of healthcare in Tanzania, and set
people and communities on the road to a brighter future.

8

Why Tanzania?
Healthy people build
healthy communities.
Tanzania is a relatively low risk country with a
growing economy. However, despite promising
economic growth,

67% of the population lives
on less than $1.25 a day.
Poverty levels indicate a significant need for
support. The wider political and economic
climate means that a donation towards the
development of Tanzania has the potential to
make a significant long term impact.

Capital City
Dodoma

Region
East Africa

Population
47.6 million

Area
364,000 sq. miles

Currency
Tanzanian Shilling

Official Language
Kiswahili

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CCBRT: A Leader in
Local Care
Starting as a small Community Based Rehabilitation
unit over 20 years ago, CCBRT has grown to be
the largest indigenous provider of disability and
rehabilitation services in Tanzania. Focused on
providing healthcare for poor and marginalized
members of the community, CCBRT provides
high quality clinical and rehabilitative services for
people with impairments such as obstetric fistula,
cleft lip/palate, cataract and clubfoot.
In order to lay the foundation for sustainable
healthcare service delivery, CCBRT works in
partnership with the Government of Tanzania.
Together, they improve the quality of care provided
to mothers and newborns in public healthcare
facilities and conduct nationwide health education
campaigns to empower individuals to seek the care
they need. Every year, through treatment, training
and advocacy, CCBRT changes the lives of over 1
million people in Tanzania.

10

Our Model

Fundraising
Kupona Foundation mobilizes funding from institutional partners and individuals in order to
fund life changing programs.

Capacity Building
Kupona Foundation connects CCBRT with highly skilled individuals, able to fill critical resourcing
gaps on the ground and train the teams in Tanzania.

Strategic Storytelling
Kupona Foundation raises the global profile of our partnership with CCBRT, strengthening our
capacity to mobilize support and raise awareness around the causes we champion.

11

Impact by the Numbers:
OVER
OVER

life changing programs

2 partnerships

with top tier business schools

Over $90,000
of equipment and supplies distributed

to public healthcare facilities

332 people gained access to family planning services and advice

dignity restored to

920
women
living with obsetric fistula

people able to see

delivered safely at supported facilities

repaired

the world around them

78,000 babies

397

smiles

7,800

$1 million

provided in support of

619 new patients enrolled in the clubfoot treatment program
12

13

Unlocking
the Potential
of People and
Communities
It starts with their health.
Improving an individualâ&#x20AC;&#x2122;s access to high quality healthcare creates a
ripple effect that reaches far beyond the individual. At optimal health,
people are able to access the educational and employment opportunities
they need to build safe and healthy futures for their family, and become
active and productive members of their wider community.
Kupona Foundation supporters enable the provision of a range of
high quality, affordable healthcare services for vulnerable groups, and
facilitate health system strengthening initiatives that improve the quality
of care for future generations.

14

Making motherhood safe for
Tanzanian women and their
newborns
Tanzania is one of the most dangerous places in the world to become
a mother.
Every year 8,000 women die as a result of pregnancy
or childbirth related causes.
160,000 more develop an injury, infection or disability
like obstetric fistula.
Every year 39,000 newborns wonâ&#x20AC;&#x2122;t survive their first
month of life.

Over 80% of these deaths are preventable.
In urban areas like Dar es Salaam, rapid population growth places deadly
strain on the healthcare infrastructure, leaving hospitals overwelmed
and ill-equipped to manage the volume of patients.
Kupona Foundation supports CCBRTâ&#x20AC;&#x2122;s efforts to address the root
causes of maternal and newborn mortality in the Dar es Salaam region.

15

Dar es Salaam is one
of the fastest growing
cities in the world.
The cityâ&#x20AC;&#x2122;s
healthcare infrastructure
was built to serve

~750,000 people.

16

The current population is
over 4 million, projected to
exceed 7 million by 2025.

Building capacity for quality care
CCBRT works with 22 public healthcare facilities in Dar es Salaam in close partnership with the Government of Tanzania.
Through direct collaboration with clinical and managerial teams, CCBRT builds capacity and ensures that patients presenting
at these facilities get the quality of care they deserve. In 2015, Kupona connected CCBRT with financial and technical support
for this life saving, game changing program.

Embedding technical advisors in clinical teams to provide skills training and on-thejob mentoring for all cadres of frontline healthcare workers.

Equipment & Supplies
Distributing life-saving equipment and supplies to public healthcare facilities to ensure clinical
teams have the tools they need to do their jobs.

Infrastructure Development
Refurbishing operating rooms and labor wards to improve patient flow, physical accessibility
and patient experience so that every woman and child receives high quality, respectful care:
no exceptions.

Data Collection & Analysis
Strengthening data collection practices and training teams in monitoring and evaluation so
that every death, incident and success is counted, evaluated, and learned from.

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In 2015, over 78,000
babies were delivered
safely at supported sites.
CCBRT distributed

over $90,000

of critical equipment and
supplies to public facilities.

CCBRT provided
training and
mentoring to 473
healthcare workers
across the region.

19

Safe surgery: Filling critical
skills gaps in Dar es Salaam
In 2015, Kupona continued to fund the secondment
of Dr. Sierra Washington, a Harvard trained OB/
GYN, to CCBRT. Thanks to the support of Kupona
donors, Dr. Washington was able to provide
focused and high quality surgical skills training at
a facility with one of the highest caseloads in Dar
es Salaam, and adapt and implement new safe
surgery checklists based on WHO guidelines at all
sites. Dr. Washington took the lead in addressing
two of the biggest risks to maternal health in the
region - a lack of access to adequate safe blood
supplies and the unmet need for family planning.
She was instrumental in developing plans and
securing necessary approvals to establish a
dedicated blood bank at CCBRT Maternity and
Newborn Hospital, and in developing a strategy
for integrated family planning services across
the spectrum of care at the new facility. Dr.
Washington also instigated the formalization of
academic partnerships through a consortium
model, structuring the way CCBRT will work with
academic institutions for knowledge exchange,
capacity building and research in the future.

20

Prevention is better than cure
Quality maternal and newborn healthcare is critical to the prevention, early identification and treatment of impairments,
whether congenital or acquired during pregnancy and childbirth. In addition to broader improvements to the quality of care
available to pregnant women, CCBRT also builds capacity for early identification and referral of impairments. In 2015, over
600 patients under the age of 5 were referred from supported sites for further treatment at CCBRTâ&#x20AC;&#x2122;s Disability Hospital.

A donation of $535 will provide a safe, quality delivery for mother and child.

21

Since CCBRTâ&#x20AC;&#x2122;s maternal and newborn healthcare capacity building program began in 2010:

The maternal mortality
rate in Dar es Salaam
has fallen by 30%.
The average quality of care score across the 22 supported facilities

is now nine times higher.
22

23

CCBRT Maternity and
Newborn Hospital
A critical new addition to the healthcare infrastructure
in Dar es Salaam, CCBRT Maternity and Newborn
Hospital will be a specialist referral center for emergency
deliveries, high risk pregnancies, and sick newborns. In
2015, the team continued to make progress with detailed
operational planning and recruitment for the new facility.
New recruits are currently serving as Technical Advisors
to the capacity building program, in advance of taking on
their clinical duties when CCBRT Maternity and Newborn
Hospital opens in 2018.
Support services at the new facility are designed to
provide integrated support for both CCBRT Disability
Hospital, and CCBRT Maternity and Newborn Hospital.
In 2015, the medical store and laundry became the first
departments in the new facility to start serving patients. In
October, the two units were officially inaugurated by the
then President of Tanzania, His Excellency Jakaya Mrisho
Kikwete.

24

Due to open in 2018, CCBRT
Maternity and Newborn
Hospital will conduct

12,000
safe deliveries each year.
The nine block
facility covers over
“CCBRT has been so helpful to us through
the trainings they provide. Now, thanks
to my training from CCBRT, I can deliver
babies using the vacuum technique and
handle emergencies like eclampsia and
postpartum hemorrhage. My facility
is performing so well now. Before the
trainings, the health center scored 12% on
baseline quality assessments. Now, it has
scored 95%.”
–Nia, Assistant Nurse In-Charge, Buguruni
Health Center, Dar es Salaam

236,000

square feet.
To date, CCBRT and
partners have invested

$10.3 million
in this project:
an investment in the health
of future generations.

25

Family Planning: The power of information
Access to family planning information and services is critical to empowering people to make informed decisions about their
sexual and reproductive health. Thanks to the generous support of Kupona donors, in memory of Tim Manchester, CCBRT
has been able to establish family planning services at Tim’s Corner, a kiosk and clinic at CCBRT Disability Hospital.

Refurbished in 2015, Tim’s Corner is a place to buy what you need and learn something new. The
kiosk sells a range of snacks, phone credit and toiletries, while also displaying informational and
educational materials on family planning. Consultations and family planning services are also
offered in the discreet clinic next door, where a trained nurse provides confidential advice and
access to contraceptive options, including male and female condoms, pills, injectables, IUDs and
implants.
In 2015, 332 people sought family planning services at Tim’s Corner, almost three times the number that visited in 2014. The
Tim’s Corner nurse, Stella, was also trained in cervical cancer screening, expanding the services available.
As part of efforts to promote family planning and the services available at Tim’s Corner, the team celebrated World
Contraception Day and Valentine’s Day. Distributing information and free condoms to CCBRT Disability Hospital clients and
staff, Tim’s Corner noted a 60% increase in kiosk customer traffic during the holiday celebrations.

26

27

Rebuilding the lives of
women with obstetric
fistula
Eradicated from the U.S. in the early 20th century,
it is estimated that up to 3,000 Tanzanian women
develop obstetric fistula every year due to a lack
of access to quality healthcare during pregnancy
and delivery. The stigma associated with their
condition leaves women isolated from their
families and communities and unable to work.
Women with fistula are some of the poorest and
most marginalized people in the world. A lack of
awareness around the condition and treatment
available means that thousands of women go
untreated every year. Consequently, there is an
estimated backlog of 21,400 women living with
chronic incontinence without seeking medical care.
Kupona Foundationâ&#x20AC;&#x2122;s partnerships with Johnson &
Johnson, Fistula Foundation and Direct Relief have
restored the dignity of thousands of women to
date, helping raise awareness about the availability
of treatment and supporting both clinical and
rehabilitative programs at CCBRT.

28

Obstetric fistula is a debilitating childbirth related injury that causes chronic incontinence as a result
of prolonged, obstructed labor.
CCBRT manages one of the largest fistula treatment programs globally, which is designed to treat both the physical and
psychosocial effects of the condition. CCBRT provides surgery, rehabilitation, food, transportation and accommodation in the
hospital free of charge. An innovative application of mobile money transfer technology, known as “TransportMyPatient,” uses
cell phones and a network of trained ambassadors to facilitate patient referral, dramatically increasing the number of patients
able to seek treatment. During an average three week stay in the hospital, patients participate in holistic therapy sessions
including counseling, music, and art therapy as a starting point in their psychosocial rehabilitation.
As part of efforts to bring high quality care closer to the community, CCBRT has established a network of six satellite fistula
service providers across the country. Every facility has been assessed against CCBRT’s high standards of care, and receives
financial support for the provision of high quality fistula surgery.
Accredited by the International Federation of Gynecologists and Obstetricians (FIGO) as a training center for fistula surgeons in
2014, CCBRT’s team shares their skills and collective experience in fistula treatment to build the capacity of the next generation
of fistula surgeons.

A donation of $700 provides a dignity restoring fistula surgery
for one woman.

29

In 2015, CCBRT restored dignity to
920 women with obstetric fistula, at
its Disability Hospital in Dar es Salaam
and through satellite facilities across
the country.

Over 1,600
ambassadors
volunteered to identify
and refer women with
obstetric fistula.

30

CCBRT trained
10 fistula surgeons from
across Sub-Saharan Africa.

Miriamâ&#x20AC;&#x2122;s Story
When I went into labor with my third child, my husband and I
were so excited to meet our new baby. We had been waiting
many years for another child.
After 12 hours, we knew there was a problem. This child did not
come as easily as my other two children and after hoping for
many hours that she would come, my husband took me to the
nearest hospital for care. When we arrived, doctors performed
an emergency surgery [Caesarian section], but it was too late. My
baby did not survive.
After the surgery I realized that I was leaking. My doctor told me
that it was caused by obstetric fistula. I stayed at the hospital for
one month to recover from the delivery, but I was told that there
were no doctors nearby that would be able to treat to my fistula.
When I returned home I tried to farm with my husband, but the
constant leaking made it very difficult. Selling our crops is the only
way we make money for our family and I felt very bad not being
able to provide for them.
One day, I met another woman in my village who had also
developed fistula too. She had been treated at CCBRT. This
woman told me that she was sure they would be able to treat my
fistula as they had treated hers. My neighbor introduced me to a
CCBRT fistula ambassador who was able to buy my bus ticket to
Dar es Salaam using the money CCBRT sent by mobile phone.
Just a few days after arriving at CCBRT, I received treatment.
After surgery I realized my prayers were answered and I would
no longer have to live with the shame of leaking. I am looking
forward to starting to farm with my husband again. Now that I am
cured, I will be able to assist in increasing my familyâ&#x20AC;&#x2122;s income.

31

32

New partnership
announcement:
Direct Relief &
Kupona Foundation
In 2015, Kupona Foundation was delighted to
welcome Direct Relief to our community of
partners. Direct Reliefâ&#x20AC;&#x2122;s support has already
facilitated vital equipment and systems upgrades
to the operating rooms at CCBRT Disability
Hospital. The investment will allow CCBRT to
continue to provide high quality surgical care
for thousands of patients every year, including
the 527 fistula patients who received surgery
at the hospital in 2015. Upgraded equipment
has also unlocked better training opportunities
for surgeons from across the continent. We
are encouraged by the potential of this new
collaboration, and look forward to working
together to improve the health and lives of
people living in poverty in Tanzania.

33

New beginnings: Socio-economic empowerment for
women with obstetric fistula.
The Mabinti Center, ‘Mabinti’, is a socio-economic empowerment program for women recovering from obstetric fistula. An extension
of CCBRT’s holistic treatment program, Mabinti runs a 12-month intensive training course for 10 women every year. Teaching
sewing and other craft skills, as well as product design, business skills, numeracy and English, the program empowers women to
become financially independent.
Graduates from the Mabinti Center leave with the skills and confidence to start their own small business or secure steady employment.
Committed to the long term well-being of every trainee, Mabinti also provides follow up support for graduates for one year after the
end of their training to help guide the women during the challenging early days of independent entrepreneurship.
The Mabinti Center operates as a social business, covering 50% of its expenses through revenue generated by product sales. The
Center employs graduates in its production unit, tasked with making products for sale in the Mabinti Center showroom, at local craft
fairs and to fulfill international orders.
Recognizing the unique support fistula survivors can give to women awaiting treatment, Mabinti Center graduates also host crochet
workshops on the fistula ward at CCBRT’s Disability Hospital twice a week. Having a trainer who has experienced fistula, and is
thriving after treatment, provides a source of comfort and inspiration during the women’s recovery.

Bringing people with
visual impairments
out of the darkness
Estimates suggest that over 740,000 people in
Tanzania live with a visual impairment. These
impairments create significant barriers to
opportunity, limiting education and employment
prospects, and restricting access to healthcare and
other public services.

Did you know? 70% of blindness
and moderate-severe visual
impairment in East Africa is treatable.
One of only three facilities equipped to provide
specialized pediatric eye care, and the only facility
to provide prosthetic eyes in the country, CCBRT is
a leading provider of high quality, comprehensive
eye care services in Tanzania. Given the volume and
variety of their patient caseload, CCBRT Disability
Hospital is also a sought after field placement for
clinicians training in ophthalmology.

Cataract is the worldâ&#x20AC;&#x2122;s leading cause of blindness. In 2015, Kupona Foundationâ&#x20AC;&#x2122;s continued partnership with WonderWork contributed
to the treatment of 291 pediatric cataract patients, restoring their sight and unlocking the opportunities that abound with access
to education.

A donation of $300 will provide a sight restoring surgery for a
child with cataract.

39

Restoring the smiles
of children with cleft
lip/palate
Around 2,500 children in Tanzania are born with a cleft lip/
palate every year, an impairment that can have a severe
impact upon nutrition and speech if left untreated. Stigma
associated with the condition also leads to children being
excluded from community activities, and bullying causes
many children and young adults to leave school before
completing their education.

Did you know? Malnutrition in children with
cleft lip/palate, painful mobility in children with
clubfoot or other orthopedic impairments, and
learning difficulties for children with lowvision can all be prevented if medical teams
present at childbirth have the training to identify
and refer birth defects in the delivery room.

Cleft lip/palate can be corrected by surgery, and if
treated early the impairment can be corrected before it
has a significant impact upon a childâ&#x20AC;&#x2122;s development. In
2015, Kupona Foundation continued its long standing
partnership with Smile Train to provide surgery for children
with cleft as well as supporting training for surgeons from
other facilities in Tanzania, building the capacity for cleft
lip/palate care nationwide.

40

41

In 2015, CCBRT
restored the smiles
of 397 patients.
CCBRT trained

80% of patients
received free
transportation
to the hospital through
TransportMyPatient.

42

3 surgeons
to provide high quality
care for children with
cleft/lip palate.

Sharifa’s Story
Sharifa is 11 months old and the youngest of three children. When her mother, Lucy, first saw Sharifa’s cleft lip/palate, she knew
something was wrong, but was not familiar with the condition.
“I was worried that Sharifa was not feeding, and that she might not grow. My family told me to send the baby to the hospital for
treatment. No one explained the causes, but they insisted that Sharifa needed surgery. At our local hospital, the nurses encouraged
me to take Sharifa to CCBRT.
It took us two days to get to CCBRT by bus. Thankfully, one of the nurses from my local hospital helped to pay for the ticket.
Sharifa needs to have two surgeries. I am so happy that CCBRT’s services are free for Sharifa. I would not have been able to afford
two surgeries.
I am not nervous about Sharifa’s treatment, because during our time at CCBRT I have already seen other babies going in for
surgery and coming out well. I hope that the surgery will allow Sharifa to fit in with other children in our village. Perhaps she will
soon be able to feed herself.
I would love for Sharifa to be a doctor one day, just like the doctors and nurses she has met at CCBRT.

43

Helping tiny feet take their first steps
Clubfoot is a debilitating congenital impairment that causes the foot to turn inwards and downwards. The deformity worsens as a
baby’s foot grows, and if left untreated a child with clubfoot will be unable to walk properly. As many as 2,200 children in Tanzania
every year are born with clubfoot.
If identified early, clubfoot can be treated without invasive surgery, instead using braces and casts to manipulate the feet into the
correct position. CCBRT advocates for this course of treatment, known as the Ponseti method, wherever possible. It is widely
considered to be the gold standard of clubfoot care globally, avoiding unnecessary pain and discomfort for the child. Kupona
Foundation’s partnership with WonderWork supports the provision of care to hundreds of children with clubfoot every year.
CCBRT’s clinical team not only provides high quality clubfoot services at the CCBRT Disability Hospital, but also trains clinicians at
other facilities in Tanzania to provide the same standard of care, bringing services closer to the children in need. In 2015, CCBRT
teams traveled to Iringa Regional Hospital to conduct clubfoot treatment and train healthcare teams. In addition, as part of the
maternal and newborn healthcare capacity building program, CCBRT’s team trained physiotherapists and a doctor at three public
facilities in Dar es Salaam, empowering them to establish weekly clubfoot clinics in their facilities and improve the frequency of early
identification and referral of impairments like clubfoot.

A donation of $160 will provide a full course of treatment for a child
with clubfoot.

44

45

CCBRT treated 619 new
clubfoot patients using
the Ponseti method across
three facilities in Tanzania.
By the end of the year,
CCBRT had over

CCBRT has

700 patients
registered for
long term treatment
for clubfoot.

46

CCBRT conducted
175 surgeries
for complex
clubfoot cases.

13 Ponseti
trained
clinicians
on staff.

Nelson’s Story
Nelson was brought to CCBRT at just one month old. When his
mother, Monica, delivered Nelson at a Dar es Salaam hospital, the
nurses told her the baby had clubfoot and she should come to
CCBRT.
“At the beginning it was really disturbing me, but I started feeling
better because relatives were encouraging me and telling me it
is a normal thing. So now I feel OK. At least nowadays people are
aware about this abnormal condition. They used to wonder ‘what
happened? Why is the baby like that?’ But people understand
more now so it is not too bad.
We heard about CCBRT through television ads, and the nurses at
the hospital where I gave birth. We would not have been able to
pay for Nelson’s treatments, so we’re really grateful that CCBRT
provides the treatment for free.
In the beginning the CCBRT staff told us that Nelson might
need surgery, but we’ve seen results using only the casting. I can
already see it working, I can see a real difference in Nelson’s feet.
I’m so happy CCBRT is here. Before, there was nowhere for
people with disabilities to go. Now there is a place for parents and
children to find treatment and comfort. I think CCBRT is the best
hospital, especially as a disability hospital.
After his treatment, I hope that Nelson will be well, and be like a
normal child. I hope that he gets a good education, walks and can
play sports with other children.”

47

Improving the mobility of children with burn scars
Burn injuries are common in Tanzania, particularly affecting children, due to the widespread use of open flames for cooking and
indoor light sources. If left untreated, burn scars can cause muscle and bone to fuse, causing severe pain and seriously impeding
mobility. Burn scars are costly to treat, requiring complex surgeries, prolonged stays in the hospital, and physiotherapy. Given the
unexpected nature of a traumatic injury, the medical costs are unplanned and place a serious financial burden on a family already
living in poverty.
Kupona Foundationâ&#x20AC;&#x2122;s partnership with WonderWork supports the provision of burn scar treatment at CCBRT Disability Hospital,
helping CCBRT to provide services for free for children under 5, and at heavily subsidized rates for older patients. In 2015, CCBRT
provided skin grafts, contracture releases and comprehensive physiotherapy for 70 people with burns, 67 of whom were under 18
years of age.

A donation of $600 will cover the cost of one surgery for a child
with burn scars.

48

49

50

Angelica’s Story
Angelica was 9 months old when she fell into the fire in the kitchen. As a baby she was in severe pain, but Angelica’s parents didn’t
understand the full consequences of her injuries until she was older. “At first, because she was so young, Angelica was nursed and
fed by members of our family. As she grew older, scarring meant that she couldn’t feed, wash or dress herself as other children
would. Her injuries also meant that she was unable to attend school, even though she was desperate to learn and play with other
children. Our community joined together to fund her treatment at a local hospital, but doctors told us to go to CCBRT for special
care. Once again, our friends and community helped us so Angelica’s father could travel with her to CCBRT’s Disability Hospital in
Dar es Salaam.”
After consultation from CCBRT’s specialist surgeons, it was revealed that Angelica would require a series of three procedures,
including contracture releases and skin grafts, to reduce scarring and increase her mobility. Thanks to the high quality care
provided by CCBRT, Angelica and her family are hopeful for the future. “We look forward to her having more independence, and
we are excited that she now has the opportunity to attend school and achieve her dreams.”

51

Enabling the
Sustainable Growth
of Life Changing
Programs
Kupona Foundation is in a privileged position to leverage expertise across
sectors, calling on innovative minds to share their knowledge and help
build scalable solutions, all to ensure the longevity of CCBRTâ&#x20AC;&#x2122;s impact on
the ground. Kupona unlocks access to a network of experienced, multidisciplinary talent in the United States, connecting CCBRT to cuttingedge thinking, opportunities for partnership and innovative approaches
that would be challenging to reach as a local Tanzanian NGO.

52

Maximizing potential:
Eliminating waste and
improving efficiency
CCBRTâ&#x20AC;&#x2122;s reputation for exemplary eye care services means that they
face consistently high demand at the Disability Hospital. Increased
efficiency is critical to sustain high quality services for everyone who
arrives at the hospital to seek treatment. CCBRT is one of the first
healthcare providers in Africa to implement lean healthcare strategies
in its facilities, adapting principles of waste reduction developed in the
manufacturing industry and applying them to the healthcare context.
Supporting CCBRT in the early stages of its lean journey, Kupona
Foundation serves as a connector, linking CCBRT with the technical
support of lean experts in the United States.
In 2015, groups from the CCBRT leadership team took part in
10-day training courses at the Thedacare Center for Healthcare
Value in Wisconsin, led by Dr. John Toussaint, a pioneer in the lean
healthcare world. In addition, Kupona facilitated a partnership with
lean management consultant Chris Kita, who traveled to Tanzania for
five weeks to support targeted lean healthcare pilots in CCBRTâ&#x20AC;&#x2122;s Eye
Outpatient Department.

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Chris’s Story
“After many years working in the manufacturing industry I was drawn to the field of healthcare because of the opportunity that it
provides to have an immediate, tangible and positive impact on people’s lives. I served in the Peace Corp at the start of my career,
and have worked as a Lean Coach at the Lehigh Valley Health Network for the last five years. I was excited to return to Africa to see
how my experience and skill-set could help CCBRT.
We decided that I could add the most value in the Eye Outpatient Department (Eye OPD). The department had to turn away
patients approximately 35% of the time because the demand for services was greater than the medical teams could handle. Our
main goal was to develop a process that would prevent patients from having to leave without receiving treatment.
Every eye patient was being seen by a doctor, regardless of their condition. Our hypothesis was that approximately 30% of
patients could be treated effectively by an ophthalmic technician, therefore freeing up the doctors’ time to deal with the most
complex cases and reducing bottlenecks to shorten wait times for all patients. On the first day of a pilot test utilizing Ophthalmic
Technicians, all Eye OPD patients were seen by 1:45pm that day, over two hours before the Eye OPD was due to close. It was a
promising start!
Lean is all about using data to understand problems, engaging frontline staff to develop an improved or new process, and then
testing assumptions using the new process. This is just the beginning. Now that we’ve conducted the first pilot tests, we’re
optimistic that we can continue moving forward with utilizing the Ophthalmic Technicians. The aim is for the Eye OPD to serve as
a model cell for lean at CCBRT, so other departments can learn how they used data, frontline staff engagement, and pilot tests to
solve their demand and capacity problems.
The team at CCBRT is passionate about giving and supporting quality care. They really do feel the pain of having to turn patients
away. Everyone at CCBRT is really committed to his or her purpose, and I admire that very much. Other lean consultants interested
in working with Kupona Foundation and CCBRT will grow not only professionally but also personally from this experience. It can
be truly life changing for them, as it was for me.

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Supporting CCBRT’s
evolution into a social
enterprise
CCBRT’s focus on providing quality healthcare
services to the poorest members of the Tanzanian
community has been historically funded through
the generosity of external donors. CCBRT
recognizes the importance of increased financial
independence to the sustained provision of
services for future generations. In 2015, CCBRT,
with Kupona Foundation’s support, took action to
scale its existing private clinic model.
This year, CCBRT’s private clinic served 17,000
patients across a range of services including
eye and orthopedic outpatient and surgical care
and physiotherapy. These patients pay a higher
fee for treatment, in return receiving additional
benefits including appointment based services,
private inpatient rooms, and air conditioned
waiting areas. Private clinic revenue is reinvested
into CCBRT, enabling the provision of free and

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subsidized treatment for poor patients. With the private
clinic at maximum capacity, and demand for services
among middle class Tanzanians growing, CCBRT began
construction on a new private clinic building to expand
services and increase revenue generation.
Kupona’s partnership with MIT Sloan School of
Management continued in 2015, when an Executive
MBA team traveled from Boston to Tanzania to support
planning for the evolution into a social enterprise. The
team conducted research and analysis and developed
recommendations for CCBRT’s business model and
organizational readiness, which fed into a roadmap and
key considerations for the journey.
To support the development of a workable sustainable
business
model,
Kupona
Foundation
also
facilitated pro bono support from Trend Discovery, a
U.S.-based consultancy. Trend Discovery evaluated
existing financial models, traveled to Tanzania to meet
with key stakeholders and applied best practices to
redesign and rebuild financial models to provide
functional, user friendly tools that would be flexible
in the face of changing circumstances and robust
enough to support CCBRT’s needs as they grow.

When open,
CCBRT’s new
Private Clinic
will serve 55,000
patients per year
– three times the
capacity of the
current clinic.
When the new expanded

Private Clinic
facility is opened,

revenue is projected
to increase by 500%.
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Addressing skilled
human resources
shortages
The need for high quality medical and managerial
training in Tanzania is undeniable. There is a severe
shortage of skilled professionals able to meet the
healthcare needs of a growing population, with
no established program of Continuing Medical
Education for licensed medical professionals in
the country. Succession planning in healthcare
facilities is challenging, with insufficient training
opportunities for young clinicians. There is also a
growing need for skilled clinicians as the industry
strives to expand the availability of quality healthcare
to meet the demands of a growing population. In the
coming years, CCBRT will face a steep increase in
internal training requirements with the recruitment
of new staff for the CCBRT Maternity and Newborn
Hospital. New staff will need to complete preemployment training and credentialing, and be
equipped to provide high quality care.
CCBRTâ&#x20AC;&#x2122;s vision is to establish a Training Center to
equip healthcare and managerial professionals

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across the region with the skills they need to deliver high quality medical care. By addressing
both internal and external training needs, CCBRT’s Training Center will improve operational
excellence, patient care and outcomes throughout the entire organization, and provide a
central location to support healthcare provider training across the East Africa region.
In 2015, Kupona Foundation’s partnership with UCLA Anderson School of Management
continued, engaging an Executive MBA team to conduct a Strategic Management Research
(SMR) consultancy to support the development of a business plan that would empower
CCBRT to plan for and eventually operate a high quality, high impact training center in a
sustainable manner.

“Over the course of our two week visit to Tanzania and Kenya in March,
we witnessed for ourselves the need for increased access to medical
care and the vital role that CCBRT plays in the region. We realized
that the smallest of contributions and changes can have the biggest
impact there.” - Matt Mather, UCLA Anderson School of Management
Executive MBA ’15, SMR consultancy team member
Funded by Kupona’s longstanding partner Johnson & Johnson, the team identified gaps
and growth opportunities, conducted extensive market research and analysis, developed a
detailed financial model to test scenarios for sustainable operating models, and identified
potential future international partnerships. The project highlighted the opportunity for
CCBRT to become a recognized leader of quality training in the region of East Africa.

59

OVER

The UCLA SMR Project by the Numbers:

100,000

miles traveled, covering three
continents and four countries.

A team of five Executive MBA students from UCLA.

Over 70 interviews
with CCBRTâ&#x20AC;&#x2122;s patients,

300+ hours
of research.

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medical and management teams,
global educators, government
officials, and other nonprofits.

61

Building a Bridge
Between the U.S.
and Tanzania
Kupona convenes a collaborative community of donors, partners,
technical experts, thought leaders, advocates and volunteers to mobilize
support and activate awareness for our life changing programs and
the causes we champion. Our activities in the U.S. give individuals and
institutions the opportunity to be a part of direct, long term change for
people and communities living in poverty in Tanzania. Our partnership
with CCBRT enables us to fuse our commitment to transparency and
sustainability with local expertise to deliver high impact programs for
the people we serve.

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Summer Cocktail Reception
Generously hosted by our Board Member, James Mann, Kuponaâ&#x20AC;&#x2122;s Annual Cocktail Reception is an intimate gathering of supporters
committed to our work in maternal and newborn healthcare. Raising over $15,000, the 2015 cocktail reception supported the
continued secondment of Dr. Sierra Washington to CCBRT, enabling Dr. Washington to continue her clinical work, skills based
training and technical advisory. This support helps to ensure that life-saving skills and techniques are embedded in the Tanzanian
healthcare system for generations to come.

Annual Golf Outing
In 2015, Kuponaâ&#x20AC;&#x2122;s fifth annual golf outing raised over $25,000 for our maternal and newborn healthcare program. As Hurricane
Joaquin gathered strength off the East Coast, a determined group of supporters and volunteers joined us at the North Hempstead
Country Club in Port Washington, NY to celebrate the progress of our program to date, and to support continued improvements
to the healthcare system in Dar es Salaam. Money raised through the outing was enough to enable 27 safe C-Sections, 72 safe
deliveries, and the training of 9 healthcare workers in quality obstetric care.

Participating in the global conversation
2015 marked a milestone in international development, with the expiration of the Millennium Development Goals and launch of the
new Sustainable Development Goals, mapping out the international development agenda for the next 15 years. Erwin Telemans, the
CEO of CCBRT, joined Kupona in New York City in September to participate in a series of partner meetings and side events centered
around one question: how are we going to achieve the Global Goals? For the Kupona team, this week solidified our belief in and
commitment to the power of partnership. Through partnerships we both maintain the integrity of our expertise and break down
silos; we can share data to inform decision making and partner with others to collect and analyze information; and we can work
together to divide and conquer these seventeen ambitious goals before the 2020 deadline.

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Guiding our
Journey
Governance
2015 saw significant changes to the Kupona Board of Directors.
After over 7 years of dedicated service to Kuponaâ&#x20AC;&#x2122;s work, the
founding Executive Director, Katie Flanagan, stepped down from
the Board of Directors. The first and only paid staff member in the
four years following Kuponaâ&#x20AC;&#x2122;s inception in 2009, Katie established
a strong foundation on which the current team continues
to build.
In June and December respectively, Kupona Foundation was delighted to
welcome two new members to the Board of Directors: Dr. John Brothers,
and Mr. Robert Schwed.

64

“I began having weekly meetings with Abbey, and found her style and commitment awesome and hard
to walk away from. The visit to Dar solidified that this is an effort I wanted to stay connected with.”
– John Brothers
An expert in the fields of philanthropy and organizational leadership, John has over 20 years of experience in nonprofit management.
He brings a new perspective to our Board, with a keen focus on strategic fundraising and organizational development specific to
the nonprofit sector. John is currently the President of the T. Rowe Price Foundation, and President of the Program for Charitable
Giving. Prior to his role at the T. Rowe Price Foundation, John was the founder and principal of Quidoo Consulting, a consulting firm
specializing in nonprofit leadership and management. It was through a pro bono consulting grant that John first started working
with Kupona. In March 2015, John traveled to Dar es Salaam to facilitate a series of strategic planning meetings with Kupona and
CCBRT, helping to align our fundraising strategies and prioritize our goals. During the trip, he saw first-hand the impact and scale of
CCBRT’s work to improve access to high quality healthcare for poor and marginalized people in Tanzania.

“Kupona is dedicated to doing the right things for the right reasons. I didn’t solely join Kupona’s Board to
write checks. I’m looking forward to the challenge of helping however I can, and really getting involved.”
– Bob Schwed
A graduate of Harvard Law School, Bob practiced law for 40 years, specializing in serving private equity firms and guiding
clients through corporate finance transactions and acquisitions. He is an adjunct professor at George Washington University
School of Law, and a recently retired partner at WilmerHale, LLP. Bob’s interest in philanthropy, and particularly healthcare in
Africa, was inspired by his family. Both his son and daughter-in-law are doctors who have worked in Africa. Bob also worked
with Dr. John Brothers before they both joined the Kupona team, to build a nonprofit serving underprivileged youth and
families in his local community in Brooklyn, NY. Bob was a longstanding supporter of Kupona’s Annual Golf Outing before
joining the Board in December 2015.

Advisory Board
With such a lean team, Kupona Foundation owes much of its success to the generosity and dedication of its Advisory Board, a group
of committed volunteers who donate their time to help Kupona grow. The Advisory Board brings a rich combination of experience
and expertise to Kupona. Members include finance, legal, and public health experts, a global advocate for essential surgery, an
investor, an entrepreneur, a technology consultant and a marketing specialist.

Kristy Bohling
Jameel Farruk
Elena Rubinov

Alison Carlman
Dr. Jaymie Henry, MD
Nick Smoot

Adam Chadroff
Rohan Mehta (Chair)
Tyler Woebkenberg

Alexandra Esparza
Mary Mei

Interested in bringing your skills and experience to our Board of Directors or Advisory Board?
Weâ&#x20AC;&#x2122;d love to hear from you! info@kuponafoundation.org

66

67

Financials
Kupona Foundation is intentionally structured as a lean organization to ensure maximum impact for donor
investments. Financial Statements and 990s are available on request.

Statement of Financial Position as of
December 31, 2015

Operating Results for the Year Ended
December 31, 2015

ASSETS

SUPPORT & REVENUE

Current Assets

Contributions

Cash

$79,628

Pledges receivable

$55,000

Total Current Assets
Property and equipment, net
Total Assets

$134,628
$1,711
$136,339

Interest Income
(Less Direct Costs of Special Events)
Total Support and Revenue

$159,717
$121
($4,623)
$1,058,661

EXPENSES
Program Services

LIABILITIES AND NET ASSETS

Total Program Services

Liabilities
Accounts payable

$9,434

Total Current Liabilities

$9,434

Net Assets

68

Contributions â&#x20AC;&#x201C; services and in-kind

$903,446

Unrestricted

$71,905

Temporarily restricted

$55,000

$1,034,973

Supporting Services
Management & General Operating

$70,716

Fundraising

$85,813

Total Supporting Services
Total Expenses

$156,529
$1,191,502

Total Net Assets

$126,905

Revenue in Excess of Expenses

Total Liabilities and Net Assets

$136,339

* Due to planned one-time strategic investments in organizational
development and program services.

($132,841)*

Summary of Expenses

Program Spending
(Financial & In Kind)

87%

Program Spending Allocation

CCBRT
Training
Center

Fistula &
Mabinti Center

35%

7%
Maternal &
Newborn
Healthcare and
Family Planning

10%
Management &
General Operating

6%

Fundraising

7%

Cataract, Burns
& Clubfoot

15%

CCBRT Core
Program
(Unrestricted)
Cleft Lip/Palate

15%

18%

Our independently audited financial statements show that nearly
9 out of every 10 dollars we spend is invested in programs and services
for people and communities living in poverty in Tanzania.

69

70

With Special Thanks To
Allen & Overy, LLP

Mr. Anthony Fuller

Mrs. Kathleen Vieira

Bill & Melinda Gates Foundation

Mr. Avery Manchester

Mrs. Rhoda and Dr. Bob Barnhard

(Matching Gifts Program)

Mr. Ed Hoyt

Ms. Elizabeth Keating

Bloomberg LP

Mr. Ed Yelochan

Ms. Joanne Moore

Cravath, Swaine & Moore LLP

Mr. George Kevlin

Ms. Jocelyn Neukom and Mr. Brian Bulloch

DA Collins Construction Co., Inc.

Mr. James Mann

Ms. Martha Schrader

Direct Relief

Mr. Jonathan Lewis

Ms. Paige Navarro

Douglas Elliman Real Estate

Mr. Josh Goldfein & Family

Ms. Patricia Potts

Drilling for Hope

Mr. Marquise Stillwell

Ms. Valerie Greer

Fistula Foundation

Mr. Marty Galasso, Jr.

PeriGen

Fulham College Boys’ School

Mr. Matt Tannin

Princeton in Africa

GE Foundation (Matching Gifts Program) Hogan

Mr. Michael Falcon

Quidoo Consulting

Lovells U.S. LLP

Mr. Paul Glist

Real Bark Mulch, LLC

Iron Roost, Inc.

Mr. Peter Haylock

Salesforce Foundation

Johnson & Johnson Family of Companies

Mr. Reggie Lenoir and Ms. Sheila Wofsy

Silicon Valley Community Foundation

Karibu Kikoy, LLC

Mr. Robert Schwed

Simpson Thacher & Bartlett, LLP

Mary Queen of Peace Church

Mr. Ronald G. Morris

Sint-Theresiacollege VZW

Massachusetts Institute of Technology (MIT)

Mr. Steven Hatfield

Smile Train

Mayer Brown, LLP

Mr. Thomas Longe

Thompson Hine, LLP

Mr. Adrian Stewart and Ms. Tara Cohen-Stewart

Mr. Timothy Godfrey

Trend Discovery

Mr. Akira Maeda

Mr. Timothy Ostrander

Vanguard Charitable Endowment Program -

Mr. and Mrs. Anton Blinkhoff

Mr. Victor Kovner

VMWare

Mr. and Mrs. Vincent D’Agostino

Mr. William Block and Ms. Kim Nguyen

WilmerHale

Mr. and Mrs. W. Steven Seaboyer

Mrs. Carolyn Chandler

WonderWork

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Looking Ahead
to 2016
In 2015, Kupona Foundation built momentum and found our stride as a
team. In 2016, we will look to diversify our activities and develop existing
partnerships in order to cultivate continued growth. By introducing
fresh and creative activities to our fundraising and strategic storytelling
portfolios we aim to engage new supporters in our work and reach a
broader audience. Plans for an art exhibition in New York City are already
underway, and our participation in the global conversation will continue
with trips to Copenhagen for the Women Deliver Conference 2016, and
New York City for UN General Assembly Week. Efforts to expand and
strengthen our Board of Directors and Advisory Board will also continue
in order to reinforce Kuponaâ&#x20AC;&#x2122;s support system, and initiatives to
streamline systems and processes will improve the efficiency and
effectiveness of our lean staff. We look forward to sharing our progress
throughout the year!

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Play your part
Protecting and preserving the health and wellbeing of an individual makes it
easier for them to complete their education and secure a steady income. This,
in turn, means they can afford to provide for their family and to send their
children to school. The health and wellbeing of the next generation improves
as a result, breaking the cycle of poverty.
Donate today, and you will set individuals and their families on the path to a
brighter future.